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For UnitedHealthcare Community Plan of Kentucky

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For UnitedHealthcare Community Plan of Kentucky

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UnitedHealthcare Community Plan of Kentucky Homepage

We know you don't have time to spare, so we put all the UnitedHealthcare Community Plan resources you need in one place. Use the navigation on the left to quickly find what you're looking for. Be sure to check back frequently for updates.”

Prior Authorization and Notification Resources

Current Policies and Clinical Guidelines

Provider Administrative Manual and Guides

For Credentialing and Attestation updates, contact the National Credentialing Center at 1-877-842-3210.

Behavioral Health Providers

Learn how to join the Behavioral Health Network, review Community Plan Behavioral Health information, or submit demographic changes at Community Plan Behavioral Health.

Facility/Hospital-Based Providers, Group/Practice Providers and Individually-Contracted Clinicians

The state-specific requirements and process on how to join the UnitedHealthcare Community Plan network is found in the UnitedHealthcare Community Plan Care Provider Manuals.  

Learn about requirements for joining our network

Overview

The Centers for Medicare & Medicaid Services (CMS) established the Medicaid Managed Care Rule to:

  • Promote quality of care
  • Strengthen efforts to reform the delivery of care to individuals covered under Medicaid and Children’s Health Insurance Plans (CHIP)
  • Strengthen program integrity by improving accountability and transparency

Enhance policies related to program integrity With the Medicaid Managed Care Rule, CMS updated the type of information managed care organizations are required to include in their care provider directories.

Helpful Resources

Pediatric Care Network will provide delegated medical management services for UHC Community Plan Pediatric Care Network members including case management, utilization management and disease management. Resources are available for providers including reference guides, office forms, frequently asked questions and more.

View Pediatric Care Network Provider Resources

Reporting Fraud, Waste or Abuse to Us

When you report a situation that could be considered fraud, you’re doing your part to help save money for the health care system and prevent personal loss for others. If you suspect another provider or member has committed fraud, waste or abuse, you have a responsibility and a right to report it. 

Taking action and making a report is an important first step. After your report is made, we will work to detect, correct and prevent fraud, waste, and abuse in the health care system.

Call us at 1-844-359-7736 or visit uhc.com/fraud to report any issues or concerns.  

Current News, Bulletins and Alerts

Support for California Residents Affected by Wildfires

Last Modified | 10.18.2019

UnitedHealthcare is taking the following actions to help those who may be affected by the recent wildfires. Our priority is making sure people have immediate and easy access to the care they need. The following actions are in place for UnitedHealthcare members residing in the following California counties.

Learn More
Optum ID Required for AARP® Provider Online Tool Website - UnitedHealthcare AARP® Medicare Supplement Plans

Last Modified | 10.17.2019

An Optum ID is now required to sign in to the AARP Provider Online Tool website for AARP® Medicare Supplement Plans, insured by UnitedHealthcare® Insurance Company. All functionality on the website remains the same.

Learn More
Get Ready for 2020 Open Enrollment by Verifying the Plans You Serve

Last Modified | 10.16.2019

At this time of year as Medicare enrollees evaluate their plan options, they may contact you to check your participation. You can prepare by verifying your UnitedHealthcare plan participation using My Practice Profile on Link or by calling us.

Learn More
10/01/2019 – UnitedHealthcare Commercial Medical Policy Update Bulletin: October 2019 (Updated Oct. 8, 2019)

Last Modified | 10.08.2019

This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Commercial Medical Policies, Medical Benefit Drug Policies, Coverage Determination Guidelines (CDG), Utilization Review Guidelines (URG), and/or Quality of Care Guidelines (QOCG).

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October 2019 Network Bulletin - Updated Oct. 3, 2019

Last Modified | 10.03.2019

In the October Network Bulletin you can learn about the Individual Health Record™, Cancer Therapy Pathways program, Smart Edits and more.

Learn More
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Accredited NCQA Health Plan Accredited NCQA Health Plan

HEDIS Medical Record Collection

Health Insurance Portability and Accountability Act (HIPAA) Information

HIPAA standardized both medical and non-medical codes across the health care industry and under this federal regulation, local medical service codes must now be replaced with the appropriate Healthcare Common Procedure Coding System (HCPCS) and CPT-4 codes. View our updated HIPAA information for UnitedHealthcare Community Plan.

Integrity of Claims, Reports, and Representations to the Government

UnitedHealth Group requires compliance with the requirements of federal and state laws that prohibit the submission of false claims in connection with federal health care programs, including Medicare and Medicaid. View our policy.

Disclaimer

If UHG policies conflict with provisions of a state contract or with state or federal law, the contractual / statutory / regulatory provisions shall prevail. To see updated policy changes, select the Bulletin section at left.